Directions form db681 2025

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The document is the Self-Insurer's Annual Report for the State of New York's Workers' Compensation Board, specifically under the Disability Benefits Law. It requires self-insured employers to report on claims and benefits related to employee disabilities, including pregnancy-related claims, for a specified calendar year. The report includes sections for total benefits and claims, employee contributions, and any changes in legal status or ownership of the self-insurer. It emphasizes accurate reporting as this data influences assessments under relevant laws.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (32 Votes)
2012	4.4 Satisfied (556 Votes)

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